The Company described below ("Applicant") hereby applies to Nelsen Steel & Wire L.P. ("Nelsen Steel") for the extension of credit in connection with purchases from Nelsen Steel:

COMPANY INFORMATION

Business Name:*

Other D.B.As:*

Billing Address:*

City:*

State:*

Zip Code:*

Shipping Address (if different from above):

City:

State:

Zip Code:

Business Phone:*

Federal Tax ID Number:*

Amount of Credit Line Requested:*

Business Fax:*

Resale Certificate No:*

Anticipated Monthly Purchases:*

Type of Business (Check all that apply):*

Screw Machine Prod

Service Center

Appliance Mfg.

Broker/Reseller

Automotive

Farm/Construction

If other type of business (explain):

Type of Company:*

Corporation

Partnership

Sole-Proprietorship

Date Business Commenced:*

Size of this location:*

How long at this location:*

Rent or Own?:*

Rent

Own

Number of Employees at this location:*

CONTACT INFORMATION

President

Name:*

Phone Number:*

Fax Number:*

Email:*

CFO/Controller

Name:*

Phone Number:*

Fax Number:*

Email:*

Buyer

Name:*

Phone Number:*

Fax Number:*

Email:*

Accounts Payable

Name:*

Phone Number:*

Fax Number:*

Email:*

BANK REFERENCES

Please identify a financial institution where the Applicant currently maintains an account and which may be contacted by Nelsen Steel for a reference:

Name of Financial Institution:*

Address of Financial Institution:*

City:*

City:*

Zip Code:*

Contact Person:*

Contact Phone Number:*

Account Number:*

Contact Fax Number:*

Type of Account:*

“I hereby authorize the release of any and all information requested by Nelsen Steel & Wire L.P. in conjunction with my application for credit.”

Applicants’ Signature:* (Must be a signer at the Bank)

Date:*

Company Name:*

TRADE REFERENCES

Please provide a minimum of three unrelated businesses which are currently providing credit to the Applicant and which may be contacted by Nelsen Steel for a reference.

Name:*

Address:*

City, State:*

Account:*

Telephone:*

Fax:*

Zip Code:*

Terms:*

Name:*

Address:*

City, State:*

Account #:*

Telephone:*

Fax:*

Zip Code:*

Terms:*

Name:*

Address:*

City, State:*

Account #:*

Telephone:*

Fax:*

Zip Code:*

Terms:*

In consideration of any credit which may be extended to applicant by Nelsen Steel, Applicant hereby agrees to the following:

1. If any credit is extended to applicant by Nelsen Steel, all such amounts will be done and payable thirty (30) days following the date of the applicants’ invoice. Any amount which is not paid when due shall bear interest from such due date at the rate of one and one-half percent (1 ½%) per month until paid in full.

2. Applicant agrees to indemnify and hold Nelsen Steel & Wire L.P. harmless from and against any and all loss, cost, damage, liability and expense (including without limitation attorneys’ fees) which Nelsen Steel & Wire L.P. may suffer or incur as a result of any failure by Applicant to pay to Nelsen any amount when due.

3. Applicant agrees to the release of any and all information requested by Nelsen Steel & Wire L.P. in conjunction with this application for credit.